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There are few motivational materials to help families with limited resources develop optimal, practical feeding strategies for young children to reduce dietary risk for poor diet and weight status. Formative evaluation strategies consisting of both qualitative and quantitative data helped to refine the parent feeding guide Eat Healthy, Your Children are Watching, A Parent's Guide to Raising a Healthy Eater. An interdisciplinary planning team developed a five-topic, multimedia, interactive guide addressing the strategies most associated with improved diet quality and weight status of children aged 3 to 5 years. Research staff conducted iterative phases of field testing, reformatting, in-depth interviews, and materials testing with Head Start or Supplemental Nutrition Assistance Program-Education caregivers (N=38) of children aged 3 to 5 years during 2011 and 2012. Convergence of feedback from caregivers' interviews and each booklet's attention, relevance, confidence, and satisfaction subscale scores were used to determine and affirm areas for improvement. Lower than desired attention, relevance, confidence, and satisfaction scores (optimal score=5) in 2011 and too much text resulted in revisions and reformatting that improved scores from 3.8 to 4.9 in 2012. The revision of materials to reflect less text, additional white space, checklists of mealtime behaviors, and learning activities for preschool-aged children resulted in dramatically improved materials and greater acceptance by parents, as shown by both quantitative and qualitative evaluations. Formative evaluation procedures involving the use of data-based decision making allowed for the development of intervention materials that met the unique needs of the population served., (Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objective: To develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model., Design: Investigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19-24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery., Results: Qualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed., Conclusions and Implications: Applying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction., (Copyright © 2014. Published by Elsevier Inc.)

Childhood obesity is a growing problem. As more researchers become involved in the study of parenting influences on childhood obesity, there appears to be a lack of agreement regarding the most important parenting constructs of interest, definitions of those constructs, and measurement of those constructs in a consistent manner across studies. This article aims to summarize findings from a working group that convened specifically to discuss measurement issues related to parental influences on childhood obesity. Six subgroups were formed to address key measurement issues. The conceptualization subgroup proposed to define and distinguish constructs of general parenting styles, feeding styles, and food parenting practices with the goal of understanding interrelating levels of parental influence on child eating behaviors. The observational subgroup identified the need to map constructs for use in coding direct observations and create observational measures that can capture the bidirectional effects of parent-child interactions. The self-regulation subgroup proposed an operational definition of child self-regulation of energy intake and suggested future measures of self-regulation across different stages of development. The translational/community involvement subgroup proposed the involvement of community in the development of surveys so that measures adequately reflect cultural understanding and practices of the community. The qualitative methods subgroup proposed qualitative methods as a way to better understand the breadth of food parenting practices and motivations for the use of such practices. The longitudinal subgroup stressed the importance of food parenting measures sensitive to change for use in longitudinal studies. In the creation of new measures, it is important to consider cultural sensitivity and context-specific food parenting domains. Moderating variables such as child temperament and child food preferences should be considered in models.

Purpose: To identify impact of an online nutrition and physical activity program for college students., Design: Randomized, controlled trial using online questionnaires and on-site physical and fitness assessments with measurement intervals of 0 (baseline), 3 (postintervention), and 15 months (follow-up)., Setting: Online intervention delivered to college students; a centralized Web site was used for recruitment, data collection, data management, and intervention delivery., Subjects: College students (18-24 years old, n = 1689), from eight universities (Michigan State University, South Dakota State University, Syracuse University, The Pennsylvania State University, Tuskegee University, University of Rhode Island, University of Maine, and University of Wisconsin)., Intervention: A 10-lesson curriculum focusing on healthful eating and physical activity, stressing nondieting principles such as size acceptance and eating competence (software developer: Rainstorm, Inc, Orono, Maine)., Measures: Measurements included anthropometrics, cardiorespiratory fitness, fruit/vegetable (FV) intake, eating competence, physical activity, and psychosocial stress., Analysis: Repeated measures analysis of variance for outcome variables., Results: Most subjects were white, undergraduate females (63%), with 25% either overweight or obese. Treatment group completion rate for the curriculum was 84%. Over 15 months, the treatment group had significantly higher FV intake (+.5 cups/d) and physical activity participation (+270 metabolic equivalent minutes per week) than controls. For both groups, anthropometric values and stress increased, and fitness levels decreased. Gender differences were present for most variables. First-year males and females gained more weight than participants in other school years., Conclusion: A 10-week online nutrition and physical activity intervention to encourage competence in making healthful food and eating decisions had a positive, lasting effect on FV intake and maintained baseline levels of physical activity in a population that otherwise experiences significant declines in these healthful behaviors.

Background: A topic of interest in the etiology of child obesity is whether and how parental feeding behaviors are associated with the food intake and weight status of children., Objective: The objective was to explore whether and how directive (overt) and nondirective (covert and food environmental structure) types of parental feeding control were associated with children's food intake and weight status., Design: This was a cross-sectional exploratory study using structural equation modeling to determine directional associations between maternal feeding practices and children's food intake and weight status. Researchers collected data from 330 dyads of children aged 3-5 y and mothers participating in a federal preschool program for low-income families (Head Start) in Michigan. The mothers' feeding practices (directive and nondirective control), the children's food intakes, and the height and weight of both the mothers and children were measured. Structural equation models tested the relations between maternal feeding practices, the children's food intake, and weight status., Results: The structural equation model confirmed that children's weight status was inversely associated with mothers' directive control, and mothers' nondirective control was associated with children's intakes of more nutrient-dense foods and less energy-dense foods. No association was found between the mothers' directive control and the children's food intakes., Conclusions: Mothers' use of nondirective feeding practices was associated with children's intakes of more nutrient-dense foods. However, use of more directive feeding control was associated with lower weight status in preschoolers of low-income mothers. These findings need to be examined in longitudinal studies. This trial was registered at clinicaltrials.gov as NCT01525186.

Parental control in child feeding has focused primarily on directive types of control, such as pressure to eat and food restriction. This study aimed to develop an instrument to assess other types of directive control and two additional aspects of parental child feeding, non-directive and food environmental control. Mothers of Head Start children (n=330) completed a 29-item instrument designed to assess these three feeding constructs and reported their children's food intakes. Researchers measured heights and weights of both mothers and children. Confirmatory factor analysis revealed that the model with three constructs did not provide an acceptable fit to the data, but an alternative model with seven sub-constructs did (Chi-square=330, df=228 p<.05, CFI=.942, RMSEA=.037). The latter model included 24 items loading onto one of the following seven factors: high control, high contingency, child-centered feeding, encouraging nutrient-dense foods, discouraging energy-dense foods, mealtime behaviors, and timing of meals. By allowing researchers to quantitatively measure feeding practices in parents with limited resources, this instrument may contribute to an improved understanding of how parental child feeding behaviors can influence children's food intakes and weight status., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Weight gain and an increase in overweight and obesity in college students raise serious health concerns. Weight management interventions for college-age men and women might be more effective if they were tailored to subgroups of students with similar behavioral and psychosocial characteristics associated with body weight status. The purpose of this study was to use cluster analysis to identify homogenous subgroups of college-aged men and women enrolled in a weight gain prevention study (Project WebHealth) using baseline data collected in 2008. Project WebHealth was a 15-month nutrition and physical activity intervention designed to decrease the rate of unwanted weight gain in 1,689 college students at eight geographically diverse universities in the United States. Outcome measures included anthropometrics, fruit and vegetable intake, physical activity, cardiorespiratory fitness, and psychosocial variables associated with weight status in college students. Cluster analysis was performed separately by sex using a two-step clustering procedure using weight-related eating and exercise behaviors and psychosocial variables. Cluster groupings were validated against students' measured weight status and waist circumference as indicators of health risk. The study design was cross-sectional. Results showed that three similar clusters were identified for each sex. Validity of the cluster solution was supported by significant group differences in body mass index and waist circumference with the High Risk cluster at elevated health risk compared to the others. For men, variability in eating competence and cognitive restraint scores contributed most to the difference between clusters, whereas for women, emotional eating and uncontrolled eating scores did. These findings could be used to improve effectiveness of messages and interventions by tailoring them to subgroups of college students with similar behavioral and psychosocial characteristics associated with elevated health risk., (Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Objective: Evaluate a theory-based, Internet-delivered nutrition education module., Design: Randomized, treatment-control design with pre-post intervention assessments., Setting and Participants: Convenience sample of 160 young adults (aged 18-24) recruited by community educators in 4 states. Study completers (n = 96) included a mix of racial/ethnic groups and family demographics, but were predominately white females without children., Intervention: A Transtheoretical Model (TTM)-based, stage-tailored Internet program, F&V (Fruit & Vegetable) Express Bites, was delivered to treatment group participants; controls received nontailored messages in a comparable format. MAIN OUTCOME MEASURES AND ANALYSIS: TTM constructs at baseline, immediately postviewing, and at 30-day follow-up were compared via chi-square, McNemar's test, and logistic regression. Qualitative use and acceptability indicators were collected postviewing (treatment only)., Results: Of baseline respondents, 86.5% completed the study. At follow-up, self-efficacy, decisional balance, and selected processes improved for both groups, with only marginal advantages for the theory-based version. Fruit and vegetable consumption changes were similar for both groups. Qualitative measures of knowledge, confidence, and motivation improved (not measured for controls). Favorable ratings of treatment program acceptability and personal relevance were reported., Conclusions and Implications: The Internet is a favorable option for reaching young adults with nutrition messages. This study did not identify strong advantages of theory-based tailoring, especially for fruit consumption, which had weaker barriers than vegetable consumption among this target audience.

Purpose: Assess effectiveness of an intervention to improve fruit and vegetable consumption in economically disadvantaged young adults., Design: Randomized treatment-control, pre-post design., Setting: Ten states., Subjects: Young adults (n = 2024, ages 18-24) were recruited from noncollege venues; 1255 (62%) completed assessment interviews at baseline and at 4 and 12 months., Intervention: Treatment participants received a series of mailed materials and two educational calls in 6 months. Controls received a mailed pamphlet., Measures: Assessment calls determined two measures of fruit and vegetable intakes, demographics and stage of change at baseline, 4 and 12 months, plus treatment participants' decisional balance, processes, and self-efficacy., Analysis: Repeated measure analysis of variance, intent-to-treat, chi2, and logistic regression., Results: At follow-up, participants in the experimental group had higher intakes of fruit and vegetables than controls (perceived daily intakes of 4.90 vs. 4.60 servings per day, F = 3.49, p < .05 and 4.31 vs. 3.92 servings/day via 5-A-Day Screener, F= 4.78, p < .01) and greater progression to action or maintenance stages (66% progress in fruitfor intervention vs. 55% progress in fruit for controls; 47% vs. 32% progress for vegetables, p = .0080 and .0001, respectively). Lower education, non-White ethnicity, male gender, living with children, and experimental group assignment predicted attrition (chi2(6df) = 288, p < .001, Cox R2 = .132)., Conclusions: Tailored educational messages and research-extension partnerships are advantageous for improving fruit and vegetable intakes of young adults.

Beverage intake and diet quality of toddlers from families with limited incomes were described and compared to their mother's beverage intake. At both 2 and 3 years of age, the children's average milk intake was adequate, the juice intake was twice that recommended, and the intake of sweetened beverages was high. Mothers who consumed more than 12 fl oz of soft drinks per day were nearly four times more likely to have a child with poor diet quality. Health practitioners should do focused screening of mothers' and children's beverage intakes to quickly assess those at high risk for poor diets.

Objective: To predict the mean adequacy ratio (MAR) scores of mothers and toddlers from intakes of fruits, vegetables, and dairy group foods and being seated during mealtimes., Design/subjects: This was a regression analysis of cross-sectional data of the diet quality and being seated during mealtimes of 100 rural mother-toddler dyads from limited-income families using two 24-hour dietary recalls. Children were 11 to 25 months of age and at or below 100% of the poverty index., Measures of Outcome: Dietary quality for mothers and toddlers was assessed using a MAR score for eight different nutrients (vitamin A, vitamin C, vitamin D, folate, calcium, zinc, iron, and magnesium), and a score of 85 or above was considered nutritionally adequate. The main food groups of interest were servings from the fruits, vegetables, and dairy group foods. Mealtime sitting behavior was the percentage of times the toddler remained seated while eating., Results: Servings of fruits, vegetables, and dairy foods predicted 0.62 of the variance in the mother's MAR score, whereas vegetable and dairy intakes along with being seated while eating indicated nutritional adequacy for toddlers. Mothers with low MAR scores were most likely to have toddlers with poor diets, although few toddlers had poor diet quality., Conclusions: Adequate intakes of dairy, vegetables, and whole fruits along with being seated while eating could be quick assessment tools to screen toddlers for nutritional risk. Mothers with poor diet quality were likely to have toddlers with poor diets; low intakes of fruits, vegetables, and dairy foods were markers for poor diet quality in mothers.

Purpose: To investigate the relationship of mothers' dietary quality to that of their infants and toddlers in limited-income families at risk for poor health., Study Design and Methods: Secondary data analysis was conducted of dietary quality from 24-hour dietary recalls collected from 113 mother-infant/toddler pairs in limited-income families with a child at age 6 months and again at age 14 months. Dietary quality of mothers was evaluated on the basis of eating breakfast and having at least one serving of the five food groups from the Food Guide Pyramid. Diet quality of infants was determined by comparison to the Women, Infants, and Children feeding guidelines for their ages; the diet quality of the mother was then compared to that of her infant and, later, toddler., Results: Most mothers and their infants had poor diet quality at the first interview. By 14 months most mothers still had poor diet quality, but diet quality for the children improved such that only about one-half remained poor. Poor diet quality of mothers was useful to detect poor diet quality for her infant or toddler showing high concordance at both interviews., Clinical Implications: A consistent marker for infants at risk for poor diet quality is having a mother who skipped breakfast and omitted fruits, vegetables, or dairy products. This could be a quick indicator to identify those at greatest risk for not following recommended guidelines in feeding their infants and toddlers.

Childhood obesity is a major health problem. Effective strategies are necessary to promote healthy eating in toddlers. The Nutrition Education Aimed at Toddlers project examined rural, low-income caregivers' knowledge, attitudes, mealtime practices, and dietary intake before and after a nutrition program. A convenience sample of 38 families participated in the study; 19 attended classes, and 19 did not. Six months after the lessons, no significant differences were found between groups; however, the resultant dietary, feeding knowledge, attitudinal, and behavioral data provide a valuable description regarding a hard to reach, high-risk population. However, caregivers' perceptions about feeding their toddlers differed from their reported dietary intakes of dairy, fruits, and vegetables. It appears that knowledge is insufficient to change eating habits. Identification of the issues that prevent caregivers in providing proper feeding is needed for a lasting change of eating habits.

This study determined whether psychosocial, weight satisfaction, and dietary pattern variables discriminate between the Stages of Change for fruit and vegetable intakes among young men and women. A random sample of 18 to 24 year-olds, from 10 states returned 1438 surveys. Discriminant analyses for fruit intake conveyed that between precontemplation and contemplation/preparation, pro-scores and self-efficacy predicted the men's but not women's stages. Between contemplation/preparation and action/maintenance, self-efficacy and breakfast consumption best predicted stage for women, whereas men were discriminated only by self-efficacy. Discriminant analyses for vegetable intake were similar by gender. Precontemplation and contemplation/preparation were discriminated by pro-score and staging into contemplation/preparation versus action/maintenance was best predicted by self-efficacy and weight satisfaction. Young men and women are at different places in the Stages of Change process and few are meeting the vegetable guidelines. Dietary interventions can be most effective if specifically tailored to food group, stage, and gender.

Objective: Examine how maternal parenting behaviors in childhood, both general and feeding specific, relate to weight status and fruit and vegetable consumption in college students. Design: Retrospective surveys on maternal behaviors and assessments on the college-aged child's current anthropometric measures and dietary intakes. Participants: College students (n = 424; 66% women). Main Outcome Measures: Students' weight, height, waist circumference, fruit and vegetable intakes, students' reports on mothers' general and feeding-specific parenting behaviors during childhood. Analysis: Correlation and regression analyses tested how maternal behaviors in childhood related to students' body mass index, waist circumference, and fruit and vegetable intake. Results: Mothers' psychological control during childhood was associated with higher body mass index and waist circumference in students, and behavioral control was associated with lower waist circumference. Parent-centered feeding behaviors related to lower fruit and vegetable intakes of students, whereas child-centered feeding behaviors related to higher fruit and vegetable intakes. Conclusions and Implications: Findings suggest that parental use of behavioral control and child-centered feeding practices and minimal use of psychological control and parent-centered feeding practices during childhood may promote a child's healthful weight status and fruit and vegetable consumption in young adulthood, specifically during college. [ABSTRACT FROM AUTHOR]